Provider Demographics
NPI:1588250765
Name:SHERROD, AIREUS L
Entity type:Individual
Prefix:
First Name:AIREUS
Middle Name:L
Last Name:SHERROD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LOVE
Other - Middle Name:HOME
Other - Last Name:HEALTH AIDES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:805 W MARION ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-2640
Mailing Address - Country:US
Mailing Address - Phone:574-206-5265
Mailing Address - Fax:
Practice Address - Street 1:494 W 23RD AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46407-3017
Practice Address - Country:US
Practice Address - Phone:219-246-3406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-12
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1119Medicaid